In health care priority setting different criteria are used to reflect the relevant values that should guide decision-making. During recent years there has been a development of value frameworks implying the use of multiple criteria, a development that has not been accompanied by a structured conceptual and normative analysis of how different criteria relate to each other and to underlying normative considerations. Examples of such criteria are unmet need and severity. In this article these crucial criteria are conceptually clarified and (...) analyzed in relation to each other. We argue that disease-severity and condition-severity should be distinguished and we find the latter concept better reflects underlying normative values. We further argue that unmet need does not fulfil an independent and relevant role in relation to condition-severity except for in some limited situations when having to distinguish between conditions of equal severity. (shrink)

Volume 19, Issue 7, July 2019, Page 30-32.

With healthcare systems under pressure from scarcity of resources and ever‐increasing demand for services, difficult priority setting choices need to be made. At the same time, increased attention to patient involvement in a wide range of settings has given rise to the idea that those who are eventually affected by priority setting decisions should have a say in those decisions. In this paper, we investigate arguments for the inclusion of patient representatives in priority setting bodies at the policy level. We (...) find that the standard justifications for patient representation, such as to achieve patient‐relevant decisions, empowerment of patients, securing legitimacy of decisions, and the analogy with democracy, all fall short of supporting patient representation in this context. We conclude by briefly outlining an alternative proposal for patient participation that involves patient consultants. (shrink)

Childhood obesity is an increasing health problem. Prior empirical research suggests that, although discussing lifestyle behaviours with parents could help prevent childhood obesity and its health-related consequences, physicians are reluctant to address parental responsibility in the clinical setting. Therefore, this paper questions whether parents might be responsible for their children’s obesity, and if so, whether parental responsibility ought to be addressed in the physician–patient/parent encounter. We illustrate how different ideal-typical models of the physician–patient/parent interaction emphasise different understandings of patient autonomy (...) and parental responsibility and argue that these models advocate different responses to an appeal for discussing parents’ role in childhood obesity. We suggest that responsibility should be attributed to parents because of their parental roles in providing for their children’s welfare. We also argue that whether, and how, this responsibility gives rise to a requirement to act depends on the parents’ capacities. A deliberative-oriented physician–patient/parent interaction best captures the current ideals of antipaternalism, patient autonomy, and shared and evidence-informed decision-making, and might facilitate parental role development. We conclude that, while not discussing parental responsibility for childhood obesity in the clinical setting can be warranted in particular cases, this cannot be justified as a general rule. (shrink)

In this article I respond to Björn Hofmann’s criticism of some elements in my theory of health. Hofmann’s main objective is to question “Nordenfelt’s basic premise that you can be ill without having negative first-person experiences, and to investigate the consequences of abandoning the premise.” One of Hofmann’s critical points is that my theory of health does not lend voice to the individual. My response is essentially conducted in four steps: (1) I question the aim of conceptual (...) analysis that Hofmann proposes for the analysis of the notion of health. (2) I maintain that my analysis, in spite of Hofmann’s contention, lends voice to the individual. It does so via my notion of subjective illness but also via my notion of vital goal. (3) I argue that conditions, such as coma, paralysis and mania are salient instances of ill health and that these may become neglected if the use of the terms “ill” and “illness” is restricted to instances where negative subjective experiences are present. (4) I rehearse my main arguments for selecting disability as the core element of ill health and respond to Hofmann’s contention that persons who are in great pain can sometimes nevertheless perform perfectly. (shrink)

‘Natural selection’ is, it seems, an ambiguous term. It is sometimes held to denote a consequence of variation, heredity, and environment, while at other times as denoting a force that creates adaptations. I argue that the latter, the force interpretation, is a redundant notion of natural selection. I will point to difficulties in making sense of this linguistic practise, and argue that it is frequently at odds with standard interpretations of evolutionary theory. I provide examples to show this; one example (...) involving the relation between adaptations and other traits, and a second involving the relation between selection and drift. (shrink)

It is a plain fact that biology makes use of terms and expressions commonly spoken of as teleological. Biologists frequently speak of the function of biological items. They may also say that traits are 'supposed to' perform some of their effects, claim that traits are 'for' specific effects, or that organisms have particular traits 'in order to' engage in specific interactions. There is general agreement that there must be something useful about this linguistic practice but it is controversial whether it (...) is entirely appropriate, and if so why it is.Many theorists have defended the use of seemingly teleological terms by appeal to an etiological notion of function (Wright, 1973; Millikan, 1984, 2002; Neander, 1991; .. (shrink)

The objective of this article is to analyse the value-ladenness of technology in the context of medicine. To address this issue several characteristics of technology are investigated: i) its interventive capacity, ii) its expansiveness and iii) its influence on the concept of disease, iv) its generalising character, v) its independence of the subjective experience of the patient. By this analysis I hope to unveil the double face of technology: Technology has a Janus-face in modern medicine, and the opposite of its (...) factual face is evaluative. (shrink)

Social entrepreneurship increasingly involves collective, voluntary organizing efforts where success depends on generating and sustaining members’ participation. To investigate how such participatory social ventures achieve member engagement in pluralistic institutional settings, we conducted a qualitative, inductive study of German Renewable Energy Source Cooperatives. Our findings show how value tensions emerge from differences in RESCoop members’ relative prioritization of community, environmental, and commercial logics, and how cooperative leaders manage these tensions and sustain member participation through temporal, structural, and collaborative compromise strategies. (...) We unpack the mechanisms by which each strategy enables members to justify organizational decisions that violate their personal value priorities and demonstrate their varying implications for organizational growth. Our findings contribute new insights into the challenges of collective social entrepreneurship, the capacity of hybrid organizing strategies to mitigate value concessions, and the importance of logic combinability as a key dimension of pluralistic institutional settings. (shrink)

A broad range of evidence regarding the functional organization of the vertebrate brain – spanning from comparative neurology to experimental psychology and neurophysiology to clinical data – is reviewed for its bearing on conceptions of the neural organization of consciousness. A novel principle relating target selection, action selection, and motivation to one another, as a means to optimize integration for action in real time, is introduced. With its help, the principal macrosystems of the vertebrate brain can be seen to form (...) a centralized functional design in which an upper brain stem system organized for conscious function performs a penultimate step in action control. This upper brain stem system retained a key role throughout the evolutionary process by which an expanding forebrain – culminating in the cerebral cortex of mammals – came to serve as a medium for the elaboration of conscious contents. This highly conserved upper brainstem system, which extends from the roof of the midbrain to the basal diencephalon, integrates the massively parallel and distributed information capacity of the cerebral hemispheres into the limited-capacity, sequential mode of operation required for coherent behavior. It maintains special connective relations with cortical territories implicated in attentional and conscious functions, but is not rendered nonfunctional in the absence of cortical input. This helps explain the purposive, goal-directed behavior exhibited by mammals after experimental decortication, as well as the evidence that children born without a cortex are conscious. Taken together these circumstances suggest that brainstem mechanisms are integral to the constitution of the conscious state, and that an adequate account of neural mechanisms of conscious function cannot be confined to the thalamocortical complex alone. (Published Online May 1 2007) Key Words: action selection; anencephaly; central decision making; consciousness; control architectures; hydranencephaly; macrosystems; motivation; target selection; zona incerta. (shrink)

In diesem Buch stellt sich die Frage nach der Wahrheit nicht über den Gegensatz von wahr und falsch, sondern im Zusammenhang mit verschiedenen Modi der Gewißheit: Wahrheit in ihren komplexen Beziehungen zu praktischen Fragen und der Notwendigkeit von Urteilen. Diese Fragen werden systematisch differenziert und historisch diskutiert. Die Autorin verdeutlicht mit dem Nachweis der entscheidenden Funktion der Urteilskraft die Verbindungen und Bruchstellen zwischen theoretischer und praktischer Philosophie. Der Urteilskraft kommt als einer individuellen Fähigkeit die Aufgabe zu, die Reaktion Anderer auf (...) das eigene Fürwahrhalten ohne eine letzte allgemeine Regel einzuschätzen. Theoretische Philosophie geht hier in politische Philosophie (Kant) bzw. in Philosophie der Psychologie (Wittgenstein) über. (shrink)

This study investigates the interrelation of outer appearance and spatial configuration of modern Chinese court buildings with the party-state’s strategy of building regime legitimacy. The spatial element of this relation is explored in four different court buildings in Kunming, Chongqing, Shanghai and Xi’an. It is argued that court buildings contribute to the empowerment of individuals who appear as parties in trials. Courthouses also facilitate the courts’ function of exercising social control and the application of an instrumentalist approach to the principle (...) of public trials. Both the grounding of court buildings in the past and their compliance with international models of a modern independent judiciary are aspects of consolidating regime legitimacy. (shrink)

Giulio Tononi's integrated information theory (IIT) proposes explaining consciousness by directly identifying it with integrated information. We examine the construct validity of IIT's measure of consciousness,phi(Φ), by analyzing its formal properties, its relation to key aspects of consciousness, and its co-variation with relevant empirical circumstances. Our analysis shows that IIT's identification of consciousness with the causal efficacy with which differentiated networks accomplish global information transfer (which is what Φ in fact measures) is mistaken. This misidentification has the consequence of requiring (...) the attribution of consciousness to a range of natural systems and artifacts that include, but are not limited to, large-scale electrical power grids, gene-regulation networks, some electronic circuit boards, and social networks. Instead of treating this consequence of the theory as a disconfirmation, IIT embraces it. By regarding these systems as bearers of consciousnessex hypothesi, IIT is led toward the orbit of panpsychist ideation. This departure from science as we know it can be avoided by recognizing the functional misattribution at the heart of IIT's identity claim. We show, for example, what function is actually performed, at least in the human case, by the cortical combination of differentiation with integration that IIT identifies with consciousness. Finally, we examine what lessons may be drawn from IIT's failure to provide a credible account of consciousness for progress in the very active field of research concerned with exploring the phenomenon from formal and neural points of view. (shrink)

The focus of this article is the analysis of generative mechanisms, a basic concept and phenomenon within the metatheoretical perspective of critical realism. It is emphasized that research questions and methods, as well as the knowledge it is possible to attain, depend on the basic view – ontologically and epistemologically – regarding the phenomenon under scrutiny. A generative mechanism is described as a trans empirical but real existing entity, explaining why observable events occur. Mechanisms are mostly possible to grasp only (...) indirectly by analytical work, based however on empirical observations. In order to achieve such an explanatory analysis, five methodological steps are suggested and discussed, among them abduction and retroduction. These steps are illustrated throughout by examples drawn from empirical research regarding social work practice. The article is concluded with a discussion of the need for knowledge of generative mechanisms. (shrink)

There has been a significant increase in the use of radiological services in the past 30 years. There are many reasons for this, but one has received little attention: the increased role of patient autonomy in healthcare. Patients demand x rays, CT scans, MRI, and positron emission tomography scans. The key question in this article is how a moral principle, such as respect for patient autonomy, can influence the extension of radiological services. A literature review reveals how patient autonomy is (...) acknowledged in radiology, and how it is used both to explain and to justify the increase in radiological examinations. Furthermore, it also shows how the premises favouring patients’ exercise of their autonomy are not always present, which makes patient autonomy subject to adverse side effects and even abuse. Patient autonomy can be used to reduce the professionals’ responsibility for radiological examinations , to increase the popularity of the profession , to increase the income of the professionals or their institutions, and to promote professional activity. Patient autonomy intended to reduce paternalism, to legitimise otherwise morally unjustifiable actions , and to protect patients, can easily be used as a moral means for opposite ends. These adverse effects are not peculiar to radiology. However, they emerge particularly clearly in explanations and justifications of the substantial increase in radiological services, as well as in debates on overuse of radiological services. (shrink)

The ‘Guiding Principles on Business and Human Rights’ (Principles) that provide guidance for the implementation of the United Nations’ ‘Protect, Respect and Remedy’ framework (Framework) will probably succeed in making human rights matters more customary in corporate management procedures. They are likely to contribute to higher levels of accountability and awareness within corporations in respect of the negative impact of business activities on human rights. However, we identify tensions between the idea that the respect of human rights is a perfect (...) moral duty for corporations and the Principle’s ‘human rights due diligence’ requirement. We argue that the effectiveness of the ‘human rights due diligence’ is in many respects dependent upon the moral commitment of corporations. The Principles leave room for an instrumental or strategic implementation of due diligence, which in some cases could result in a depreciation of the fundamental norms they seek to promote. We reveal some limits of pragmatic approaches to coping with business-related human rights abuses. As these limits become more apparent, not only does the case for further progress in international and extraterritorial human rights law become more compelling, but so too does the argument for a more forceful discussion on the moral foundations of human rights duties for corporations. (shrink)

This book is the first monograph that takes a comprehensive approach to Jacques Derrida as a philosopher of technology. It refines and complements his mainstream image as a philosopher of language and deconstructionist of classical literary and philosophical texts. This volume outlines the key features of Derrida’s alternative philosophy of technology, a philosophy which Sjöstrand argues, avoids the problems associated with, on the one hand, a Heideggerian orientation, which completely separates thinking and technology and, on the other, an empirically oriented (...) ”post-phenomenology” that can be said to be hegemonic within the field today. Based on a sustained interpretation of Derrida, and a robust, coherent philosophy of technology, a phenomenology of technology is developed that, in a radical way, extends the concept of technology to cover the entire field of phenomenology. This places the technological not in opposition to humanity, but rather always already in close proximity to man and, consequently, to life, ethics, politics, democracy and religion. Strikingly, this important aspect of Derrida’s thinking is only rarely analyzed or discussed by his many exegetes. This text appeals to graduates and researchers working on Derrida, phenomenology, and the philosophy of technology. (shrink)

In 2017, Tom Gruber held a TED talk, in which he presented a vision of improving and enhancing humanity with AI technology. Specifically, Gruber suggested that an AI-improved personal memory (APM) would benefit people by improving their “mental gain”, making us more creative, improving our “social grace”, enabling us to do “science on our own data about what makes us feel good and stay healthy”, and, for people suffering from dementia, it “could make a difference between a life of isolation (...) and a life of dignity and connection”. -/- In this paper, Gruber’s idea will be critically assessed. Firstly, it will be argued that most of his pro-arguments for the APM are questionable. Secondly, the APM will also be criticized for other reasons, including the risks and affects to the users’ and other’s privacy and the users’ autonomy. (shrink)

It is commonly thought that natural selection explains the rise of adaptive complexity. Razeto-Barry and Frick have recently argued in favour of this view, dubbing it the Creative View. I argue that the Creative View is mistaken if it claims that natural selection serves to answer Paley’s question. This is shown by a case that brings out the contrastive structure inherent in this demand for explanation. There is, however, a rather trivial sense in which specific environmental conditions are crucial for (...) the rise of specific adaptations, but this is hardly what opponents of the Creative View are denying. (shrink)

The assertion “he could have done otherwise” represents a notorious problem in the science of penal law and in moral philosophy. Some philosophers have assumed that this statement is to be analysed as “he would have done otherwise if he had so chosen” (analysis view), thus believing to have found an interpretation which is compatible with determinism. It has been argued, however, that these two statements are not equivalent. The following article attempts to show that this objection is not far-reaching (...) enough. At the same time the analysis view is considered to be of little help, as it presupposes the solution of the problems it claims to solve. (shrink)

The issue of the biological origin of consciousness is linked to that of its function. One source of evidence in this regard is the contrast between the types of information that are and are not included within its compass. Consciousness presents us with a stable arena for our actions—the world—but excludes awareness of the multiple sensory and sensorimotor transformations through which the image of that world is extracted from the confounding influence of self-produced motion of multiple receptor arrays mounted on (...) multijointed and swivelling body parts. Likewise excluded are the complex orchestrations of thousands of muscle movements routinely involved in the pursuit of our goals. This suggests that consciousness arose as a solution to problems in the logistics of decision making in mobile animals with centralized brains, and has correspondingly ancient roots. (shrink)

In discussions of moral responsibility for collectively produced effects, it is not uncommon to assume that we have to abandon the view that causal involvement is a necessary condition for individual co-responsibility. In general, considerations of cases where there is “a mismatch between the wrong a group commits and the apparent causal contributions for which we can hold individuals responsible” motivate this move. According to Brian Lawson, “solving this problem requires an approach that deemphasizes the importance of causal contributions”. Christopher (...) Kutz’s theory of complicitious accountability in Complicity from 2000 is probably the most well-known approach of that kind. Standard examples are supposed to illustrate mismatches of three different kinds: an agent may be morally co-responsible for an event to a high degree even if her causal contribution to that event is a) very small, b) imperceptible, or c) non-existent (in overdetermination cases). From such examples, Kutz and others conclude that principles of complicitious accountability cannot include a condition of causal involvement. In the present paper, I defend the causal involvement condition for co-responsibility. These are my lines of argument: First, overdetermination cases can be accommodated within a theory of coresponsibility without giving up the causality condition. Kutz and others oversimplify the relation between counterfactual dependence and causation, and they overlook the possibility that causal relations other than marginal contribution could be morally relevant. Second, harmful effects are sometimes overdetermined by non-collective sets of acts. Over-farming, or the greenhouse effect, might be cases of that kind. In such cases, there need not be any formal organization, any unifying intentions, or any other noncausal criterion of membership available. If we give up the causal condition for coresponsibility it will be impossible to delimit the morally relevant set of acts related to those harms. Since we sometimes find it fair to blame people for such harms, we must question the argument from overdetermination. Third, although problems about imperceptible effects or aggregation of very small effects are morally important, e.g. when we consider degrees of blameworthiness or epistemic limitations in reasoning about how to assign responsibility for specific harms, they are irrelevant to the issue of whether causal involvement is necessary for complicity. Fourth, the costs of rejecting the causality condition for complicity are high. Causation is an explicit and essential element in most doctrines of legal liability and it is central in common sense views of moral responsibility. Giving up this condition could have radical and unwanted consequences for legal security and predictability. However, it is not only for pragmatic reasons and because it is a default position that we should require stronger arguments (than conflicting intuitions about “mismatches”) before giving up the causality condition. An essential element in holding someone to account for an event is the assumption that her actions and intentions are part of the explanation of why that event occurred. If we give up that element, it is difficult to see which important function responsibility assignments could have. (shrink)

Aneuploidy, an aberrant number of chromosomes in a cell, is a feature of several syndromes associated with cognitive and developmental defects. In addition, aneuploidy is considered a hallmark of cancer cells and has been suggested to play a role in neurodegenerative disease. To better understand the relationship between aneuploidy and disease, various methods to measure the chromosome numbers in cells have been developed, each with their own advantages and limitations. While some methods rely on dividing cells and thus bias aneuploidy (...) rates to that population, other, more unbiased methods can only detect the average aneuploidy rates in a cell population, cloaking cell‐to‐cell heterogeneity. Furthermore, some techniques are more prone to technical artefacts, which can result in over‐ or underestimation of aneuploidy rates. In this review, we provide an overview of several “traditional” karyotyping methods as well as the latest high throughput next generation sequencing karyotyping protocols with their respective advantages and disadvantages. (shrink)

Psychoanalytic work with children is popular, but the sophisticated language used in psychoanalytic discourse can be at odds with how children communicate, and how best to communicate with them. _Dialogues with Children and Adolescents: A Psychoanalytic Guide _shows how these aims can be achieved for the most effective clinical outcome with children from infancy up to late adolescence. _Björn Salomonsson_ and _Majlis Winberg Salomonsson_ draw on extensive case material which reveals the essence of communication between child and therapist. They enfranchise (...) the patient of all ages as an equal participant in the therapeutic relationship. Presented in letter form the cases contain no professional terms. Only the final chapter contains theoretical commentaries applicable to each case. These terms and theories help to explain a child’s behaviour, the analyst’s technique and the background to the disorder. This is new creative development in child therapy and analysis which is written in a very accessible style. _Dialogues with Children and Adolescents_ will be essential reading for beginners in psychoanalytic work with children and will cast a fresh light on such work for more experienced clinicians. It will also appeal to the non-professional lay reader. (shrink)

Is technology value-free or is it value-laden? How does technology affect human autonomy? These questions, viewed within the context of medicine, are the focus of attention in this article. The central argument is that we need neither to subscribe to the value-neutrality dictum nor to the all-encompassing value-ladenness thesis to explain the pertinent position of technology in medicine. Technology is constitutive of and strongly implicated in difficult questions of value. This, however, does not mean that technology is identical to (or (...) neutral to) these value-laden questions. Technology poses issues of value, but only some of these relate to technology qua technology. Hence, it makes a difference whether we discuss general questions of value posed by technology or whether we discuss the value-ladenness of technology. Admitting technological value-ladenness does not imply that we are subject to a technological imperative that reduces our autonomy, on the contrary, it explains how technology increases our responsibility. This is particularly prominent in medicine. (shrink)

Against the backdrop of China’s rapid social change in recent decades, this article explores the social categorizations of class and citizenship and how these have evolved in terms of structure and discourse. In order to do so, possibilities of employing Beck’s theory of second modernity to the case of China are explored. While China does not fit into Beck’s theory on all accounts, it is argued here that his individualization thesis can be fruitfully employed to make sense of China’s ongoing (...) process of modernization. It may provide a welcome new starting point for analyses of China’s current social developments beyond the “simple” modernization theories that still dominate in China studies. (shrink)

It is commonly thought that natural selection explains the rise of adaptive complexity. Razeto-Barry and Frick have recently argued in favour of this view, dubbing it the Creative View. I argue that the Creative View is mistaken if it claims that natural selection serves to answer Paley’s question. This is shown by a case that brings out the contrastive structure inherent in this demand for explanation. There is, however, a rather trivial sense in which specific environmental conditions are crucial for (...) the rise of specific adaptations, but this is hardly what opponents of the Creative View are denying. (shrink)

In this paper, we try to shed light on the ontological puzzle pertaining to models and to contribute to a better understanding of what models are. Our suggestion is that models should be regarded as a specific kind of signs according to the sign theory put forward by Charles S. Peirce, and, more precisely, as icons, i.e. as signs which are characterized by a similarity relation between sign (model) and object (original). We argue for this (1) by analyzing from a (...) semiotic point of view the representational relation which is characteristic of models. We then corroborate our hypothesis (2) by discussing the conceptual differences between icons, i.e. models, and indexical and symbolic signs and (3) by putting forward a general classification of all icons into three functional subclasses (images, diagrams, and metaphors). Subsequently, we (4) integratively refine our results by resorting to two influential and, as can be shown, complementary philosophy of science approaches to models. This yields the following result: models are determined by a semiotic structure in which a subject intentionally uses an object, i.e. the model, as a sign for another object, i.e. the original, in the context of a chosen theory or language in order to attain a specific end by instituting a representational relation in which the syntactic structure of the model, i.e. its attributes and relations, represents by way of a mapping the properties of the original, which hence are regarded as similar in a relevant manner. (shrink)

"Forgetting" plays an important role in the lives of individuals and communities. Although a few Holocaust scholars have begun to take forgetting more seriously in relation to the task of remembering—in popular parlance as well as in academic discourse on the Holocaust—forgetting is usually perceived as a negative force. In the decades following 1945, the terms remembering and forgetting have often been used antithetically, with the communities of victims insisting on the duty to remember and a society of perpetrators desiring (...) to forget. Thus, the discourse on Holocaust memory has become entrenched on this issue. This essay counters the swift rejection of forgetting and its labeling as a reprehensible act. It calls attention to two issues: first, it offers a critical argument for different forms of forgetting; second, it concludes with suggestions of how deliberate performative practices of forgetting might benefit communities affected by a genocidal past. Is it possible to conceive of forgetting not as the ugly twin of remembering but as its necessary companion? (shrink)

Although popular, control accounts of privacy suffer from various counterexamples. In this article, it is argued that two such counterexamples—while individually resolvable—can be combined to yield a dilemma for control accounts of privacy. Furthermore, it is argued that it is implausible that control accounts of privacy can defend against this dilemma. Thus, it is concluded that we ought not define privacy in terms of control. Lastly, it is argued that since the concept of privacy is the object of the right (...) to privacy if the former cannot be defined in terms of control, neither can the latter. (shrink)